I think there is some confusion over what happens in burns. The clinical condition would be a critical third degree burn involving over 30% surface area. It is true the onset is acute, but the condition has to be considered a chronic one in which a series of acute problems arise. It is however the duration of the treatment period until skin coverage of the burns is accomplished that most effects survival. As mentioned previously burn patients who survive the initial stages ie. don't die of respiratory problems or fluid shifts, go into an extreme hybermetabolic state which persists until coverage is accomplished. It is very difficult to provide sufficient caloric replacement and negative nitrogen balance occurs. This causes protien wasting with muscle and organ loss and most importantly immune imcompetence. The great suseptabilty of these pts to bacterial infection combined to their lack of typical responses to infection eg. no temp rise or white cell response makes diagnosis of infecion an ongoing challenge. The clinical histories of these patients frequently include several episodes of sepsis survived followed by one they don't. I am therefore uncertain as to how an Atrin trial might be designed.
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